Valvular Diseases Flashcards by Zuli Khatun

what is S3?

heard 0.1s after second heart sound, rapid ventricular filling chordae tendinae

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S4?

ALWAYS ABNORMAL, STIFF HYPERTROPHIC VENTRICLE. turbulent flow le lub dub

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erbs point?

3rd intercostal space left sternal border, heart sounds

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special manoeuvre to hear mitral stenosis?

turn on left hand side

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special manoeuvre to hear aortic regurgitation?

sit up, lean forward breath out and hold

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which murmur goes towards carotids?

aortic stenosis

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which murmur goes towards left axilla?

mitral regurgitation

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in stenosis what do you get?

hypertrophy of chamber

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when you get regurgitation the chamber becomes?

dilated

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mitral stenosis is caused by?

infective endocarditis, rheumatic heart disease

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mitral stenosis type?

mid diastolic low pitched rumbling. loud lub then dub durrr
palpate a tapping apex beat loud S1
malar flush- due to back pressure rise in CO2 and vasodilation
associated with atrial fibrillation

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mitral regurgitation?

incompetent mitral valve
pan systolic murmur
high pitched whistling BURRRR
radiates to left axilla
associated with congestive heart failure, reduced ejection fraction, backlog blood
might hear 3rd heart sound

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causes of MR?

idiopathic with age
ischaemic heart disease
infective endocarditis
rheumatic heart disease
connective tissue disorders

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aortic stenosis?

ejection systolic murmur, high pitched, crescendo-decrescendo
radiates to carotids
slow rising pulse
narrow pulse pressure
exertional syncope

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aortic stenosis?

chest pian, sob, syncope
ejection systolic murmur, high pitched, crescendo-decrescendo. thrill
radiates to carotids
slow rising pulse
narrow pulse pressure
exertional syncope
soft/absent s2
s4
decreases following valsalva manoeuvre

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cause of AS?

idipathic age calcification
rheumatic disease
bicuspid aortic valve
williams syndrome- supravalvular
HOCM

aortic regurgitation?

aortic valve incompetent
early diastolic soft murmur
corrigans pulse/collapsing
rapidly appears then disappears
results in heart failure/ pulmonary oedema
austin flint- heart at apex
wide pulse pressure

aortic regurgitation causes?

idiopathic age related weakness
connective tissue disorders

grading murmurs?

Grade I: Difficult to hear
Grade II: Quiet
Grade III: Easy to hear
Grade IV: Easy to hear with a palpable thrill
Grade V: Audible with stethoscope barely touching the chest
Grade VI: Audible with stethoscope off the chest

what is an austin flint murmur?

This is heard at the apex as a diastolic “rumbling” murmur. This is caused by blood flowing back through the aortic valve and over the mitral valve, causing it to vibrate.

water hammer pulse?

quickly appearing then rapidly disappearing- radial artery

tricuspid regurgitation?

pan-systolic murmur. There is a split second heart sound due to the pulmonary valve closing earlier than the aortic valve, as the right ventricle empties faster than the left ventricle.
Thrill in the tricuspid area on palpation
Raised JVP with giant C-V waves (Lancisi’s sign)
Pulsatile liver (due to regurgitation into the venous system)
Peripheral oedema
Ascites

when is lancisi’s sign seen?

tricuspid regurgitation

causes of tricuspid regurgitation?

Pressure due to left-sided heart failure or pulmonary hypertension (“functional”)
Infective endocarditis
Rheumatic heart disease
Carcinoid syndrome
Ebstein’s anomaly
Connective tissue disorders, such as Marfan syndrome

pulmonary stenosis?

ejection systolic murmur loudest in the pulmonary area in expiration. There is a widely split second heart sound, as the left ventricle empties much faster than the right ventricle.

signs of pulmonary stenosis?

Thrill in the pulmonary area on palpation Raised JVP with giant A waves (due to the right atrium contracting against a hypertrophic right ventricle) Peripheral oedema Ascites

pulmonary stenosis is associated with?

Noonan syndrome Tetralogy of Fallot

teratology of fallot consists of 4?

Ventricular septal defect (VSD) Overriding aorta Pulmonary valve stenosis Right ventricular hypertrophy

management of AS?

if symptomatic- valve replacement if not but valvular gradient>40 with features of left ventricular systolic dysfunction consider surgery transcatheter AVR- high operative risk balloon valvuloplasty- children no aortic valve calcification and adults with critical aortic stenosis not fit for valve replacement

difference in pulmonary and aortic stenosis?

aortic- louder on expiration pulmonary louder on inspiration

difference in mitral and tricuspid regurgitation?

both pansystolic, but tricuspid becomes louder during inspiration

management of mitral stenosis?

patients with associated atrial fibrillation require anticoagulation currently warfarin is still recommended for patients with moderate/severe MS there is an emerging consensus that direct-acting anticoagulants (DOACs) may be suitable for patients with mild MS who develop atrial fibrillation symptomatic patients percutaneous mitral balloon valvotomy mitral valve surgery (commissurotomy, or valve replacement)

Features of aortic regurgitation?

quincke's sign (nailbed pulsation), de musset's sign head bobbing austin flint murmur middiastolic in severe AR Eponymous signs of aortic regurgitation: Corrigan's - exaggerated carotid pulse Quinke's - nailbed pulsation De Musset's - head nodding Duroziez's - diastolic femoral murmur Traube's - 'pistol shot' femorals

ventricular septal defect murmur?

harsh and pansystolic

investigations for mitral regurgitation?

ECG may show a broad P wave, indicative of atrial enlargement Cardiomegaly may be seen on chest x-ray, with an enlarged left atrium and ventricle

investigations for mitral regurgitation?

ECG may show a broad P wave, indicative of atrial enlargement Cardiomegaly may be seen on chest x-ray, with an enlarged left atrium and ventricle

treatment options for mitral regurgitation?

Medical management in acute cases involves nitrates, diuretics, positive inotropes and an intra-aortic balloon pump to increase cardiac output If patients are in heart failure, ACE inhibitors may be considered along with beta-blockers and spironolactone